Neurophysiological Approaches (a critique)

Neurophysiological Approaches (a critique)

Author(s):
Larry Silver M.D.

Reprinted with Permission From:
International Dyslexia Association (info)

Printed Date: Spring 2001

Date Posted on this Website: October 03 2002

"Four neurophysiological approaches for treating learning disabilities are considered controversial: patterning, cerebellar-vestibular dysfunction, applied kinesiology and EEG Biofeedback."

Four neurophysiological approaches for treating learning disabilities are considered controversial. One, patterning, has been proposed since the mid-1960s. Although less noted in the United States, it is still proposed in Canada and in Europe. Another relates to the concept of cerebellar-vestibular dysfunction. It's major proponent continues to actively stress his intervention. The third relates to what is called applied kinesiology and utilizes cranial bone manipulation. Although less advertised now, one still hears of it. The fourth relates to the use of EEG Biofeedback to treat learning disabilities.

Patterning

The theory and technique of patterning was initially developed by Doman and Delacato (1968). The underlying concept follows the principle that failure to pass properly through a certain sequence of developmental stages in mobility, language, and competence in the manual, visual auditory, and tactile areas reflects poor "neurologic organization" and may indicate "brain damage."

The proposed treatments involve repetitive activities using specific muscle patterns in the order the child should have learned if development had been nonnal, e.g., rolling over, sitting, crawling, standing, and walking. The method is described in their literature as reaching, "all of the stimuli normally provided by his environment but with such intensity and frequency as to draw, ultimately, a response from the corresponding motor systems." In the more severe cases of proposed brain damage, patterns of passive movement are imposed that have as their goal, "the production of nonnal activities which would have been the product of the injured brain level had it not been injured."In addition to these methods of manipulation, other techniques used may include sensory stimulation, rebreathing of expired air with aplastic face mask (claimed to increase vital capacity and to stimulate cerebral blood flow), and restriction of fluid, salt, and sugar intake (claimed to decrease cerebrospinal fluid production and cortical irritability.

The American Academy of Pediatrics along with the American Academy for Cerebral Palsy published statements expressing concern about the effectiveness of this form of therapy (1982). This policy statement on the Doman-Delacato treatment of neurologically handicapped children reported that, after reviewing all of the relevant literature, the conclusion was that "the patterning treatment offers no special merit, that the claims of its advocates are unproven, and that the demands on families are so great that in some cases there may be harm in its use."No research has been published that supports the theory nor the interventions as a treatment for learning disabilities. Yet, interventions based on the patterning concepts remain popular in some countries.

Cerebellar - Vestibular Dysfunction

Several investigators have suggested that the vestibular system is important in learning. They claim that there is a causal relationship between vestibular disorders and poor academic performance involving reading and written language in children with Learning Disabilities. Ayres, (1973), Frank and Levinson (1973), and Levinson (1980) suggest that such children require a specialized therapy before they can benefit from academic input. DeOuiros (1971) and Levinson (1984) suggest that evidence of a vestibular disorder is predictive of learning disabilities and that therapy can prevent these disabilities.

In recent years, Levinson has published several books on the causative role of the vestibular and vestibular-cerebellar systems in learning disabilities. He proposes the treatment of dyslexia with anti-motion sickness medication to correct the vestibular dysfunction. No research is cited in his books to support his theory or the effectiveness of his treatment. His books refer to his clinical observations and case examples. In one book (Levinson, 1984), he proposes multiple other interventions along with the anti-motion sickness medication, including many other types of medication plus special education.

The role of the vestibular system in the higher cortical functions required for academic performance is not known. Some of the symptoms generally associated with learning disabilities (faulty eye movements, poor postural coordination, poor balance, and poor spatial orientation) could be indicative of vestibular disorder. Such symptoms, however, are only indirect evidence for vestibular dysfunction. The most prorninent objective sign of vestibular involvement is nystagmus (spasmodic, rapid movement of the eyeball from side to side).

The hypothesis that there is a relationship between vestibular function and the academic learning of reading and written language comes chiefly from the authors noted. Ayres used the Southern California Postrotary Nystagmus Test. In this test, the child is rotated in alighted room with eyes open, which provides both visual and vestibular stimulation. Thus, it may not be a valid test of vestibular function. Frank and Levinson, used "blurring speed" as evidence for abnormal vestibular function. This was described as the speed at which words passing across the visual field can no longer be recognized. But, because this involves the passing of stimuli across the subject's visual field at varying speeds, it constitutes visual stimulation, not vestibular.

Consequently, none of the work of these investigators has provided conclusive evidence for vestibular dysfunction in individuals with learning disabilities. These data could possibly be interpreted as evidence of visual dysfunction. Other studies on vestibular dysfunction in children with learning disabilities have reported negative or equivocal results as well.A study by Polatajko (1985) investigated the relationship between children's vestibular function and academic learning using well-defined criteria for learning disabilities and exact measurements of vestibular activity. The evaluation of vestibular function consisted of examination of calibration records, search for spontaneous and gaze nystagmus, testing smooth pursuit, and vestibular and optokinetic testing.

Vestibular nystagmus was induced by a rotating chair. No significant differences either in the inbsity of vestibular responsivity or in the prevalence of vestibular dysfunction were found between the normal learning children and children with learning disabilities.

There was no evidence that children having low, average, or high vestibular responsivity differed significantly on measures of academic performance. There was no significant correlation between measures of vestibular function and measures of academic performance.In summary, there is no current evidence supporting the theory of vestibular dysfunction nor supporting the proposed treatment approaches. Yet, the primary proponent of this treatment for learning disabilities remains extremely busy evaluating and treating these children.

Applied Kinesiology

There are fewer clinicians proposing this form of therapy. However, variations on the original treatments continue to be used. The movement began when some chiropractors in the United States advertised that they could cure dyslexia and learning disabilities. The literature that was distributed referred to the use of "applied kinesiology" and to the work of Dr. Carl A. Ferreri (Ferreri, Wainwright, 1984). The claim was that his treatment could result in an astounding reversal of all dyslexia and learning disability conditions. Often, it was stated that this technique produced measurable results immediately, often after one treatment.The basis for the theory and proposed treatment was a book written by Dr. Ferreri and Dr. Richard Wainwright, Breakthrough for Dyslexia and Learning Disabilities (1984).

This book was produced by a small publishing group and distributed by Dr. Ferreri's own center. The book offers no research data. There is one reference cited over and over to a study done by Dr. Ferreri (1983). It was difficult to get a copy of this reference. It was published as a one-page article in a non-professional magazine and described his concepts and proposed treatment. There was no data or references to research.In this book the authors theorize that learning disabilities are caused by damage to two specific cranial bones, the sphenoid and the temporal, by what they call "cloacal reflexes," and by an ocular muscle imbalance they term an "ocular lock." They report that, "the learning disabled will exhibit one or two sphenoidal faults in combination with a positive cloacal reflex and a probable ocular muscle lock. The dyslexic ... will show three or four spehenoidal faults, at least one temporal fault, as well as a collection of other reflex failings." (Farreri, Wainwright, 1984)

The Cranial Faultsp

The authors speculate that the learning disabilities occur because the displacement of the sphenoid and temporal bones causes neurologic problems by creating unequal pressure areas on the brain. If this is true, they assert, then "an almost infinitesimal bony manipulation" will correct the disability and the symptoms will disappear.These authors claim that the cranial bones do move and that these changes can apply pressure through the various protective layers between the brain and the skull and impact the brain. They also believe that the diaphragm is connected to the vertebrae, pelvis, and skull through bands. They speculate that these bands extend through the opening at the base of the skull, wrap around the vessels and nerves, and join the lining (dura) that surrounds the brain and the spinal cord, affecting the reception of stimuli and the reflexes, balance, and neuronal functions. Because of these anatomic connections, such movements of the cranium adversely affect brain functions, resulting in learning disabilities. They claim that their technique for restoring the cranial bones to their proper positions through skull manipulations will correct the brain malfunctions.

The Cloacal Reflexes

These authors describe cloacal reflexes, which they believe are located in the anterior and posterior surfaces of the pelvis. They report that these reflexes center the pelvis and coordinate with "visual righting," "labyrinthine righting reflexes," and "tonic neck receptors" to center the head and neck with the lower part of the body. They speculate that if all these reflexes are not synchronized, the mechanical and/or chemical integrity of the body will be thrown out of balance. Again, they claim that manipulating these sites results in disappearance of symptoms.

The Ocular Lock

This term is used to describe a neural problem created when the eyes move in certain directions. Muscles weaken and the eyes get heavy; thus, motion is hard to follow and it becomes difficult to coordinate lines of print and to read. Because the eye muscles attach to the cranial bones, if these bones have been out of position for a long time, the authors reason that the eye muscles may become shorter and function inadequately. Once again, they propose that the eyes will function well when the cranial bones are manipulated into the correct position.Ferreri and Wainwright propose a treatment that involves specific body manipulations to correct the difficulty with cranial faults, cloacal reflex functioning, and ocular muscle imbalance. They report in their book that, "most learning disabled have responded in a positive way in one to three treatments and have remained clear of symptoms on a schedule of reinforcement visits."Once the neurologic and structural corrections are made, the person is cured and able to learn what he or she was not able to learn before. The next phase of treatment is referred to as "catch up." That is, the individual must learn all that he or she did not learn before the correction. Remedial tutoring is necessary. If the child does not make progress with tutoring, the authors suggest that the cranial bones may have slipped back out of position and further treatment is required.The proposed theory and interventions are not based on any known research. Some of the views are based on anatomic and functional concepts not held by the majority of anatomists. There is no research on outcome. A professional organization of chiropractors has stated a disclaimer to this approach. Parents should be encouraged not to consider using it.


EEG Biofeedback

It is difficult to do a comprehensive review of this proposed treatment approach. Much, if not most of the literature on EEG Biofeedback as a treatment for learning disabilities is found in flyers and other literature provided by Dr. Siegfried Othrner, Susan Othrner, and others. This literature focuses on training courses for professionals or information for parents. In these materials one reads, "EEG Biofeedback is currently the fastest growing and most effective biofeedback modality. It gives mental health and educational professionals a powerful tool for effectively changing the physiological basis of behavior, mood, attention, and learning problems."Listed among the disorders that can be treated with this approach are ADD/ADHD and Specific Learning Disabilities. Many other disorders are often listed: conduct disorders, sleep disorders, PMS & menopause, stroke, epilepsy, to name a few.Studies are often published in EEG Spectrum, a newsletter format paper published by Dr. Othmer.

A research bibliography is often handed out at conferences. Many of the references are old, predating the proposed treatment. Some have interesting titles but, when read, do not relate to the topic; and some are in non-edited publications. Thus, it is difficult to find the references helpful in assessing this treatment approach.At best, I can say that the theory has not been scientifically documented. There is no body of research literature supporting the treatment approach nor showing outcome studies. The primary spokesperson, Dr. Siegfried Othmer, provides his literature and training in the use of this treatment. I mentioned the limitations noted above at a conference. Shortly after this conference, I received a letter from Dr. Othmer (1994).

He agreed that there was a lack of research and suggested that the reason was that "the research community" will not participate. He defended his courses by saying, "The course is intended to teach professionals how to apply the technique, and is not intended to dwell for three days on the fundamental case for efficacy of this technique.

"In summary, the use of EEG Biofeedback to treat learning disabilities has not, to date, been shown to be effective nor has the theory behind the treatment been found to be correct. Yet, this approach, which is time consuming and expensive, continues to be sought after by parents looking for a faster treatment for their child's disability.


References

American Academy of Pediatrics (1982). The Doman-Delacato treatment of neurologically handicapped children: A policy statement by the American Academy of Pediatrics. Pediatrics 70:810-812.

Ayres, A.J. (1973). Southern California post-rotary nystagmus test. Los Angeles, Western Psychological Services, 1973.

DeOuiros, I.B. (1971). Diagnostico differencial de la dislexia especifica. Fonoaudiologica Buenos Aires 17: 117 -123.

Doman, G., Delacato, C. (1968). Doman-Delacato philosophy. Human Potential, 1:112-116.

Ferreri, C.A. (1983). Dyslexia and learning disabilities cured. Digest of Chiropraaic Economics 25:74.

Ferreri, C.A., Wainwright, R.B. (1984). Breakthrough for dyslexia and learning disabilities. Pompano Beach, FL, Exposition Press of Florida.

Frank, J. Levinson, H.N. (1973). Dysmetric dyslexia and dyspraxia: Hypothesis and study. J Am Acad Child Adolesc Psychiatry 12:690-701.

Levinson, H.N. (1980). A Solution to the Riddle of Dyslexia. New York, Springer-Verlag.

levinson, H.N. (1984). Smart but Feeling Dumb. New York, Warner Books.

Othmer, S. (1994) Personal communication Polatajko, H.I. (1985). A critical look at vestibular dysfunction and learning-disabled children. Dev Med Child Neurol 27:283-292

Dr. Larry Silver is the Theme Editor for this issue of Perspectives and his bio can be found on page four.
http://dyslexia.mtsu.edu/modules/articles/displayarticle.jsp?id=69